Stop Health Care Fighting, Start Fixing

The next step in health care reform for Minnesota is to establish a health insurance exchange, a unique opportunity to put a Minnesota stamp on the Affordable Care Act. However, if we are not ready by 2013, the federal government will step in and establish a federally-run exchange. That would be embarrassing considering Minnesota's reputation as a health care leader and home to organizations such as the Mayo Clinic.

Minnesota progressives have proposed plans to establish an exchange, efforts stymied by the conservative-controlled legislature. The most frustrating aspect of conservatives' objections to the exchange is that the idea of an exchange fits their world view perfectly, and is probably why Pawlenty supported exchanges when he was governor.

The exchange is all about encouraging competition as a remedy to a broken-market. The preliminary Minnesota exchange would be an online market place consisting of plans that meet certain coverage requirements (divided in to four categories: platinum, gold, silver, bronze) based on affordability and quality of coverage. An exchange would allow consumers to compare, contrast, and choose what is best for them.

Conservative hostility towards reform is nothing more than political; they don’t want to appear to be supporting the Obama Administration by taking action on his signature legislative achievement. They have refused to participate in the advisory committee charged with laying the groundwork for the exchange.

Additionally, they have refused to fund it, instead the advisory committee runs on grants from the federal government and reform organizations. Conservative lawmakers even imposed a cap on the amount of money the Department of Commerce can spend on an exchange, which has forced the agency to decline $3 million dollars in federal grants, according to a Kaiser Family Foundation fact sheet. Their truculence could cost Minnesota the ability to run our own exchange. Governor Dayton said that it is unlikely he can fully establish an exchange without legislative action.

From a policy perspective, exchanges are absolutely necessary. Nine percent of Minnesotans are currently uninsured and will benefit greatly from the exchanges. The CBO estimates that the exchanges will provide insurance for 23 million Americans. By encouraging competition between providers and requiring more transparency about plans, insurers will have to compete for every person by offering better coverage at a more affordable price.

A Health Affairs study compared the quality of insurance now with the quality of insurance that would be available in an exchange. It made two important conclusions. First, a lot of insurance sold in the individual market now is pretty terrible. In fact, it was so bad that researchers had to create a new category for it: tin. Second, the insurance that will be available on the exchanges will be better than a lot of what is in the current market. Even the worst insurance on the exchanges will be better than the status quo.

Health insurance exchanges are not a radical concept, they have existed and have been discussed as crucial element of health care reform for decades. For example, both Massachusetts and Utah had established insurance exchanges long before ACA's passage. Even conservative Congressman Paul Ryan included one in his budget. Furthermore, one survey found that three-quarters of registered Minnesota voters support the establishment of the exchanges.

With the Supreme Court’s decision out of the way, we can move forward with the necessary policies to achieve greater access and more comprehensive care. For Minnesota, that requires establishing the insurance exchange mandated in the ACA. There is real work to be done to improve on Minnesota’s health care system and conservatives need to be a part of these discussions. It is time they start showing up to the meetings.

It’s time for health reform supporters to call the conservative opponents for what they are. We’re too polite and that lets them claim legitimacy for their opposition. They’re not legitimate. It’s Republicans who block the reforms America needs. It’s Republicans who oppose “death panels” but would let us die quietly in our beds for want of medical care. It’s Republicans who would let the insurance companies cut us off when we need their help. It’s Republicans who fight giving reasonable help to people in need, because they’re too cheap and irresponsible to help solve the problem. ‘Better they should die and decrease the surplus population,’ to quote Mr. Scrooge.

No, it’s Republicans who would make a social virtue of mean-spirited stinginess. So let’s call them for what they are!